HomeMy WebLinkAbout1991-07-09; City Council; Resolution 91-217c
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RESOLUTION NO. 9 1 - 2 17
A RESOLUTION OF THE CITY COUNCIL OF THE
CITY OF CARLSBAD, CALIFORNIA,
AUTHORIZING THE EXPENDITURE OF FUNDS
FOR SETTLEMENT OF THE WORKERS
COMPENSATION CLAIM OF DAVID ISELSO
WHEREAS, HCM Claim Management Corp., the Third Party Administrator for the
City of Carlsbad, has recommended a settlement in the Workers Compensation case of
David Keko; and
WHEREAS, there are sufficient funds available in the Workers Compensation Self-
Insurance Fund to pay the settlement,
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of
Carlsbad, California, as follows:
1.
2.
That the above recitations are true and correct.
That the expenditure of $7,315 from the Workers Compensation Self-
Insurance Fund is authorized for the settlement of said case.
3. That the Council accept the Stipulations with Request for Award, attached
hereto as Exhibit 2.
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PASSED, APPROVED AND ADOPTED at a Regular Meeting of the City
Council of the City of Carlsbad on the gth
vote, to wit:
day of Ju1Y . 1991, by the following
AYES: Council Members Lewis, Kulchin, Larson, Nygaard and St
NOES: None
ABSENT: None
ATTEST
CL&zL?!. Q-
ALETHA L. RAUTENKRANZ, City C1 rk
!
- 0 0 EXHIBIT
WOZKERS' COMPENSAiiCiU APPEALS BOARD
STATE OF CklIFORNiA .
Unassigned Case No. \
Stipulations
with Request
€or Award
i Applicant
David Kelso
.. ... ..
. . .. __ ..-
, 3om 03-21-48 , whi!e
i---- vs.
City of Carlsbad
- .-. -- ... .-
Dqedrats
-. -. __ .
. . ....
The parties hereto stipulate to the issuance oi an Award and/or Order, based upon the foilowing facts, and
waive the requirements O€ Labor Code Section 313:
1. David Kelso
i Empioyee )
07-23-89 I' on employed within the State of Caiifornia as -r ire Engineer ( Occupanon) i Date oi !siury)
City of carlsbad whose compensation insurance carrier was
satbed injury arising OU: of and in the course of employment to rFght kne€
7-27-89 through 7-31-89 and 8-7.
( Employer) OY
;io.I Claim Mqt.
(?am of body injured)
2. The injury caused temporary disabiliv for the period
8-28-89 for which indemniw is payable at S 224.00 pe.
&rough
week, Iess credit for such payments previously made. ( ful ly compensated)
15 la7 140. GO 3. The injury mused permanent &ability' of -,c, for which indemnity is payable at s
per week be,ainning foMwith
payments previously made.
h domal rating has - , in &e sum of s 7 t 315.00 , less credit for SUC]
been previously issued.
(Sei& one)
4. There- may be need for rnedicai treatment to cure or relieve from the effects OE said ink=
.> - ..- - . ._ .. . . . . . ... ( Select one) :-.. -
Upon demd, limited to inj-wy - herein mentioned, defendmLhas; L.5;,da&o
autiorize or show good cause for denial.
licwt tacid authority -to secure: whatever Failure to.do S~$S-L+& q$!xe app-
is n~*~M~o#Q&L?*Ai *EL*TIO cure or relieve the effects of injmy. ' :-I.. OIV&IIOH oc INOUSTRIAL ACCIO~N
g?=J 85 93: 01.4 WUS SM?al 3 (-53. 5-75> ( Page 1)
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WORKERS’ C@APENbAl iUN APYtAm WNKU -. ‘ e STATE OF CALIFORNIA
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5 Xfedical-legal expenses are payable by defendant as follows. i’Ione
6 .\ppiicant’s attorney request a fee of S N/ A
7 Liens agamst compcsation are payable as follows: None
._ -- -
S. Other sripulacons :
Parties acree to waive interest 3n che Award if
pzid wi~fiin 20 days of serv-ce.
(&q- g/
@t David Kelso 1200 Calrsbad Village Dr.
570-76-1246 Carlsbad, Ca 93008
Social Seccnty Number of Applicant -4ddress of Enplover
1171 Phillips Dr. 3954 Plurphy Canyon Rd. iD205
Vista, Ca 92083 San Djego, Ca 97172
Address of Applicant
?TI A Attorney or Authorzed Rhresentaave for Deiendan 3954 Murphy Canyon Rd. fD205
.Address of .Attome\. or .iuchonzed Represenratrve
-
Attorney for ,-ippfiaRt
N/ A San Diego, Ca 92123
-- ___ .iddress of Attorney for Aopiicanc
--... - __ DEPARTMENT OF IHOUSTRI~L RELATIC
JIVlSlOH OF INDUSTRIAL AC=:DEI 1 I.( 13 !J
3IA WCA3 FOXM 3 (SEV 5-73) iPage2j ;Sij sJ 8 I~qf -_ -_ -. -_